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Managed health care companies' lobbying frenzy.

The top dozen national managed health care companies and two industry trade groups spent at least $2,023,041 on lobbying expenses and campaign contributions to key lawmakers during last year's health care debate, according to an analysis of Federal Election Commission data and federal lobbying disclosure forms. Five of the top six spenders are large insurance companies that are rapidly transferring their business from traditional indemnity insurance to HMOs. Over half--52 percent--of campaign donations from the top managed care companies' and trade associations' PACs and employees went to members sitting on the five Congressional committees with jurisdiction over health care reform.

Financial Support

State legislators' perceptions of lobbyists and lobbying on tobacco control issues.

OBJECTIVE: To determine state legislators' perceptions about health and tobacco lobbyists, their frequency of contact with these lobbyists, and the amount of campaign contributions from health professional organisations and the tobacco industry. DESIGN: Cross-sectional study. SUBJECTS: State legislators from North Carolina, Texas, and Vermont (USA), serving in 1994. MAIN OUTCOME MEASURES: Perceptions about lobbyists representing the tobacco industry, non-profit health organisations, and state medical societies with respect to their credibility, importance as sources of information, and persuasiveness; extent of lobbying activities; campaign contributions from health professional organisations and the tobacco industry. RESULTS: Almost all legislators reported that medical society and non-profit health organisation lobbyists are credible on tobacco issues and just over half believed that these lobbyists are important sources of information. More legislators said they could be persuaded by medical and health lobbyists than by tobacco lobbyists. Although health professional Political Action Committees (PACs) gave campaign contributions to more state legislators, and gave higher amounts on average, than tobacco PACs, legislators reported less contact with medical society lobbyists than tobacco lobbyists about tobacco issues. CONCLUSIONS: State legislators have positive attitudes toward lobbyists for non-profit health organisations and state medical societies regarding tobacco issues. These groups may be an underused resource for educating legislators about tobacco control measures.

Cross-Sectional Studies

Well-healed: inside lobbying for health care reform, Part II. Center for Public Integrity.

The Center for Public Integrity conducted a year-long investigation of the decision-making processes of the U.S. government during its work on health care reform. The results suggest that health care reform has become the most heavily lobbied legislative initiative in recent U.S. history. In 1993 and 1994, hundreds of special interests spent over $100 million to influence the outcome of this public policy issue. In Part II, the authors describe some of these special interests, including the insurance industry, both the largest companies and those that make up the Health Insurance Association of America; doctors, hospitals, and other health care providers; the pharmaceutical industry; businesses of all sizes; and the tobacco industry.

American Hospital Association

Well-healed: inside lobbying for health care reform, Part I. Center for Public Integrity.

The Center for Public Integrity conducted a year-long investigation of the decision-making processes of the U.S. government during its work on health care reform. The results suggest that health care reform has become the most heavily lobbied legislative initiative in recent U.S. history. In 1993 and 1994, hundreds of special interests spent over $100 million to influence the outcome of this public policy issue. In Part I, following a summary of the study and an introduction explaining the methodology, the authors provide a brief history of other health care reform efforts attempted in this century and examine the evolution of the Clinton plan, from its inception through the task force process to its release.

Financial Support

Well-healed: inside lobbying for health care reform, Part III.

The Center for Public Integrity conducted a year-long investigation of the decision-making processes of the U.S. government during its work on health care reform. The results suggest that health care reform has become the most heavily lobbied legislative initiative in recent U.S. history. In 1993 and 1994, hundreds of special interests spent over $100 million to influence the outcome of this public policy issue. In Part III, the authors conclude their description of these special interests, including political organizations, the elderly, labor, and public interest groups and foundations. The report concludes with a discussion of how the work of Congress is influenced by political contributions to individual members of Congress and to the Democratic and Republican parties, trips sponsored by the health care industry, and investments held by members of Congress in health care-related industries.

Fund Raising

Lobbying: the best kind can be self-taught.

The Pennsylvania Medical Society pays professional staff to lobby for its members, as do almost all specialty groups in each state and in Washington, DC. Paid lobbyists have specific legislative responsibilities, but their efforts cannot be the only ones put forth on behalf of physician interests.

Health Policy

Group art therapy in a methadone clinic lobby.

A weekly group art therapy workshop, held in the waiting room of the Venice (California) Methadone Clinic of the Los Angeles Institute for Studies of Destructive Behavior, is described. In this workshop, the clients project their imagination onto random lines and shapes made by string and ink on paper, drawing out the images they see and writing titles and sometimes stories about them. The artwork is shared, discussed, and displayed in the lobby. Through this art-centered process, the clients learn to communicate feelings and conflicts with each other. They also develop social skills, gain insight, and improve their self-esteem. Group art therapy, when combined with counseling, is an effective therapeutic modality when working with a nonverbal and resistant population such as drug abusers.

Adult

Lobbying for international health: the link between good ideas and funded programs: Bread for the World and the Agency for International Development.

Historically, the Agency for International Development (AIDS) health budget has been closely tied to overall development spending. A large increase in the international health appropriations in 1984 broke this pattern. Investigation shows that active grass roots organizing and congressional lobbying are the most likely responsible factors in the increase. Maintenance and expansion of this success will require increased recognition of and participation in these activities by individuals and organizations involved in international health.

Child Health Services

Lobbying: everyone's responsibility.

Health legislation is increasingly important to us as citizens and infection control professionals. The clearest need for influencing policymakers is in cost-cutting activities and the resulting impact on health care delivery. Health care professionals (HCPs) can highlight for lawmakers those health systems that are cost-effective and beneficial to the public. HCPs can help explain to constituents the costs and the scientific reasons for proposed changes. Additionally, HCPs are aware of nonmonetary costs, including emotional and social deficits, or indirect costs, of health-related programs. These should be addressed in the discussion of costs with government officials. Infection control personnel have shown effective means of reducing the cost of health care. ICPs must publicize their role in cost saving at the government level, as well as within individual institutions. Protecting the patient's welfare and cost control do not often go in tandem in this country's multibillion dollar health care industry. Infection control is almost unique in this respect. It is crucial to our patients, the employers for whom we work, and to ourselves that we share this information with those who decide public policy.

Communicable Disease Control